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What It’s Really Like to Be a Pediatric Cardiologist

In our 9–5 series, we ask our favourite boss babes what a day in the office entails. This week, pediatric cardiologist Dr. Emilie Jean-St-Michel gives us a glimpse into her daily grind at Toronto’s Hospital for Sick Children (SickKids)

Education: Completed CEGEP (Quebec’s public post-secondary program) with an M.D. from McGill University. Currently working on her masters in clinical epidemiology at the University of Toronto

Length of time at current gig: Nine years at Toronto’s Hospital for Sick Children (SickKids)

Did you always know that you wanted to be a doctor? I knew I liked science and math—my favourite subjects in high school—and I wanted a job where I could help people, so becoming a doctor felt like a perfect fit. As I went through CEGEP and discovered more about biology, I also got really fascinated by the disease processes.

What attracted you to pediatric cardiology specifically? It was a series of opportunities. When I did my prep year for medical school, one of the professors, , did a lecture about pediatric cardiology. I was fascinated by everything he was saying. I went and talked to him at the end of the class and said that I would love to do research for him. He initially said no, but I was persistent and eventually worked for him for the summer. That’s where I discovered even more about pediatric cardiology. As I went through medical school, cardiology remained one of my strongest interests, so I ended up choosing it as a career path.

Now as a staff cardiologist at SickKids, what does your job entail? We give kids a second chance by supporting them with tools like a mechanical heart and then a heart transplant, so they can get back to a normal life. The main bulk of my work is heart failure in heart transplant-related patients, so I see a big variety of patients. Part of my work is following families and patients that are known to have genetic disease of the heart muscle, called cardiomyopathy. I also work with children who have congenital heart disease, meaning that they’re born with a structural abnormality in their heart, things are missing or aren’t in the right place. They go through surgical therapy, but sometimes, unfortunately, things happen where that doesn’t work and then my team and I look into other options for them.

How is working with children different than working with adults? You have to connect with the child, and that differs depending on age, but you have to find something to connect with them so that they are willing to let you examine them and ask questions. It’s a challenge, but also a pleasure that comes with working in pediatrics. With little babies you smile at them at that’s often enough. If I want to listen to the heart of a child, I will ask them where their heart is. Often they’re too shy and afraid of you so they don’t answer, so I’ll point to my head and say, “Is it in your head?” and they’ll say no. “Is it in your foot?” And they’ll say no. And then they’ll point to their chest. It’s just this little game that allows them to be less scared of you so you can get close to them and actually have a listen.

You work closely with the families as well. Have there been any particularly memorable moments with parents? These families are incredible. They go through stuff that you can’t imagine going through yourself. There was one mom in particular. I noticed that she had two blankets, she left one with her child and kept another with her, and I asked her why. She then taught me that once a child chews on a blanket (i.e., her blankie), you want to make sure you have more than one, so you have a spare ready for any situation—which I have now done for my child. It’s my brain forever; this mom was in such a tough situation, yet she took the time to explain this trick to me.

What does is an average workday like for you? It depends if I’m “on service” or not because I don’t see patients every day of the year. When I’m on service, I’m usually at the hospital for 7:30 a.m., in meetings until 9 a.m. where we talk about patients with different teams, and then doing rounds and looking at every single patient until around noon. The beauty of rounds is that we round with the team, so we have a dietician, a social worker, nurses, occupational therapists, pharmacists and many others with us that help us navigate every patient. They also help to remind us, since my team is more medical, about the other factors that need to be looked after. After that’s all done, we meet with the families that have more questions or that have decisions to make. I closely review the imaging or recent testing. Then we meet with other specialists, in case there are questions related to other organs. We also have family meetings to discuss what’s going on, or to sometimes give bad news, which unfortunately happens.

It must be tough to have those conversations. How have you learned to deliver bad news? Through training, I’ve had many years of following other people and observing how the staff pediatrician or cardiologist gave the bad news to families and navigated the options with them. From all those different encounters, I kept pieces of what I liked and created my own style—something I could be comfortable with, and then I saw how people reacted to me and adjusted along the way. For instance, if I want to have an important discussion, I sit down with the patient and have the right people from our team around so they can give their expertise to the family. It’s not an easy part of our job, but it’s a very important part of our job. We can help the families almost as much in those situations as when we are able to cure the patient.

How do you personally deal with the emotional side of this job? It’s hard at times, but it’s also great. In the highs and in the lows we have a great role to play with the family to support them. At the same time, it needs to be an emotional experience for you, otherwise you wouldn’t be doing a good job. It’s all part of finding balance.

How do you stay motivated in your work? I’m in the business of curing people and helping people feel better, and for most patients, we succeed in doing that. That’s our ultimate goal. The times when it doesn’t work, those patients stay in your mind more, but ultimately I’m able to stay motivated because my job is a very positive one. I get to help kids, old and young, have a healthy life.

Before seeing a patient and their family, how do you get yourself in the zone? By reviewing my numbers. I’m a scientist at heart. I look at the data, I make sure I’ve very confident with it, and that helps me plan what I will say to the patient from a medical standpoint.

You mentioned earlier that you got into the profession to help people—is there a particular case where you really felt like you were able to do that? I don’t know if there’s one patient in particular, it applies to all the patients. There’s something very special in taking a baby who has been in the hospital her whole life, giving her a heart transplant and sending her home with her family and following her years later and seeing her grow into a healthy kid. That applies to so many kids that I care for.

What do you hope to achieve with your career? I want to make my mark. I would love to find something novel that could change patient care. Right now, I’m researching the factors that are associated with worst outcome in patients. One of the biggest questions we get is parents wanting to know what’s going to happen—not just tomorrow, but in five years and beyond—will their child go to go university, get married…? So I’m trying to help predict that so I can give those families answers.

Who is a physician that you admire and why? , who was the division head of cardiology. He just has an understanding of physiology of cardiology better than anyone else I know and potentially better than anyone else in the field. I admire his knowledge. I always say that if I could just have a small part of his brain, I would probably do very well.

What attributes does someone need to be a pediatric cardiologist? I think you need to be passionate and dedicated. We work hard, and it takes many hours and many sacrifices to get here.

How do you unwind at the end of your day? A nice dinner with my husband. We both like to cook, so once the baby is in bed, we have a nice meal.

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